Joann E. Manson

Hormone therapy is an appropriate choice for some, but not all, women. On the benefit side, hormone therapy relieves hot flashes, night sweats and vaginal dryness, and it may improve sleep, mood and concentration. It also preserves bone density and protects against fractures. But there also are risks, including higher rates of breast cancer, stroke, blood clots in the legs and lungs and, for older women, coronary heart disease. What questions do you and your doctor need to answer to make an informed decision about hormone therapy? And if you choose hormone therapy, how can you minimize the risks? Here are the key elements of that conversation.Moderate to severe symptoms, which affect about one in five newly menopausal women, are the only compelling reason to take hormone therapy. If you're bothered by vaginal dryness only, consider low-dose vaginal estrogen rather than pills or patches.Mounting evidence indicates that a woman's age and time since menopause (on average at the age of...

Pendulum swings are common in medical research. So some people yawned--and others grinned--when they heard about recent studies that concluded being overweight isn't so bad for us after all. If only it were so. The truth is that numerous studies involving hundreds of thousands of patients followed for decades have shown that the risks for diabetes, heart disease, hypertension, stroke and even cancer are linked to being overweight or obese. And the more excess weight we have, the greater the risk for these diseases--and for an early death.All this makes sense from what we now understand about fat tissue, especially the visceral fat tissue that accumulates deep in the abdomen, enlarging our waists in the process. It's biologically act-ive tissue that churns out hormones and chemical messengers that cause insulin resistance, inflammation and increased blood clotting. So when we gain too much weight around our middles, we're wreaking havoc on our health.The studies that suggest that...

Pendulum swings are common in medical research. So some people yawned--and others grinned--when they heard about recent studies that concluded being overweight isn't so bad for us after all. If only it were so. The truth is that numerous studies involving hundreds of thousands of patients followed for decades have shown that the risks for diabetes, heart disease, hypertension, stroke and even cancer are linked to being overweight or obese. And the more excess weight we have, the greater the risk for these diseases--and for an early death.All this makes sense from what we now understand about fat tissue, especially the visceral fat tissue that accumulates deep in the abdomen, enlarging our waists in the process. It's biologically act-ive tissue that churns out hormones and chemical messengers that cause insulin resistance, inflammation and increased blood clotting. So when we gain too much weight around our middles, we're wreaking havoc on our health.The studies that suggest that...

Women entering menopause are understandably confused about whether to take hormone therapy. Estrogen is the most effective way to beat hot flashes. It also eases vaginal dryness and may improve your sleep, mood and concentration. But many women are wary after recent studies showed that taking hormone therapy may increase vulnerability to heart disease, causing the risks to outweigh the benefits. What do you need to know to make your decision?A little history helps. Until a few years ago, many doctors believed that estrogen protected against heart disease, a leading killer of women in developed countries. Large observational studies found lower rates of heart disease and bone fractures in women taking estrogen. Those same studies also identified risks from hormone therapy: higher rates of breast cancer, stroke and blood clots in the legs or lungs. Recently, however, reports from randomized clinical trials, including the Women's Health Initiative, have suggested that hormone therapy...

Women enteringmenopause are un-derstandably con-fused about wheth-er to take hormone therapy. Estrogen is the most effective way to beat hot flashes. It also eases vaginal dryness and may improve your sleep, mood and concentration. But many women are wary after recent studies showed that taking hormone therapy may increase vulnerability to heart disease, causing the risks to outweigh the benefits. What do you need to know to make your decision?A little history helps. Until a few years ago, many doctors believed that estrogen protected against heart disease, the leading killer of U.S. women. Large observational studies found lower rates of heart disease and bone fractures in women taking estrogen. Those same studies also identified risks from hormone therapy: higher rates of breast cancer, stroke and blood clots in the legs or lungs. Recently, however, reports from randomized clinical trials, including the Women's Health Initiative, have suggested that hormone therapy might actually...